MEDICARE: INTEGRATED OB GYN SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	D22219	MD

General Provider Information

NPI Number	:	1568547883
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTEGRATED OB GYN SERVICES

Provider Business Mailing Address
First Line	:	7610 PENNSYLVANIA AVE
Second Line	:	SUITE 305
City	:	FORESTVILLE
State	:	MD
Zip	:	20747-4701
Country	:	US
Telephone Number	:	301-669-1870
Fax Number	:	301-669-1873

Provider Business Practice Location Address
First Line	:	7610 PENNSYLVANIA AVE
Second Line	:	SUITE 305
City	:	FORESTVILLE
State	:	MD
Zip	:	20747-4701
Country	:	US
Telephone Number	:	301-669-1870
Fax Number	:	301-669-1873

Authorized Official
Title or Position	:	PRACTICE ADMIN
Name	:	MS. CORALEE POWELL
Credential	:
Telephone Number	:	301-669-1870

Provider Enumeration Date	:	10/26/2006
Last Update Date	:	04/11/2008

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